In response to proposed changes to the Medicare Advantage and prescription drug programs for contract year 2026, the ACR submitted comments on the provisions related to the Inflation Reduction Act, prior authorization and the influence that pharmacy benefit managers have on the placement of biosimilars on formularies.
Talking to Patients About Medicare Choices: Q&A with the Arthritis Foundation’s Nick Turkas, MS
Access to care is critical for treating arthritis and other chronic rheumatic conditions. That’s why choosing the best Medicare plan fit is such an important decision. Use these tips from the Arthritis Foundation’s Nick Turkas, MS, to help your patients make their best choice for insurance coverage.
Few Medicare Advantage Plans Cover Social Needs for Chronically Ill Patients
(Reuters Health)—Most Medicare Advantage plans are not offering chronically ill enrollees supplemental benefits to address social needs, which were added to the government health program in 2018 in an effort to improve health outcomes and achieve cost savings, a U.S. study suggests.1 Researchers examined publicly available data on benefits and plan design for Medicare Advantage…
Update & Changes to the OIG Work Plan
Early last fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its OIG Work Plan for fiscal year 2018–2019, which is a two-year framework for the audits, inspections, evaluations and investigative activities planned in support of its vision, mission, and strategic goals and objectives to maintain HHS program integrity….
U.S. Accuses UnitedHealth of Medicare Advantage Fraud
(Reuters)—The U.S. Justice Department (DOJ) has accused UnitedHealth Group Inc. of obtaining inflated payments from the government based on inaccurate information about the health status of patients enrolled in its largest Medicare Advantage Plan.1 The complaint, filed in federal court in Los Angeles on Monday, came after the DOJ earlier this year intervened in two…
U.S. Justice Department Has Concerns about Aetna-Humana Deal
(Reuters)—The U.S. Department of Justice has significant concerns about Aetna Inc.’s proposed acquisition of health insurer Humana Inc., a source familiar with the situation said on Thursday, and shares of Humana fell more than 11%. Aetna’s purchase of Humana would combine two of the largest providers of Medicare Advantage plans for elderly people, and investors…
U.S. to Raise Payments to Insurers for Medicare Advantage 2017 Plans
NEW YORK (Reuters)—U.S. health insurers that provide Medicare Advantage plans to elderly and disabled Americans will receive government payments in 2017 that are 0.85 percent higher on average than in 2016, reflecting small anticipated growth in medical costs, the U.S. Department of Health and Human Services said on Monday. Health and Human Services’ final plan…
U.S. Proposes Hike in Medicare Advantage Payments; Insurer Shares Rise
NEW YORK (Reuters)—The U.S. government on Friday proposed raising payments by 1.35% on average next year to the health insurers who offer Medicare Advantage health benefits to elderly and disabled Americans. Payments to insurers will vary under the 2017 Medicare Advantage proposal, based on the region the plans are sold and on the size of…
Aetna’s Deal for Humana May Push Up Costs for Seniors
WASHINGTON (Reuters)—Aetna Inc.’s plan to buy smaller insurer Humana Inc. for $31 billion will mean seniors will pay higher Medicare Advantage premiums, according to a new report by the think tank Center for American Progress (CAP). Aetna’s proposed deal for Humana would combine Aetna’s 7% of the Medicare Advantage market with Humana’s 19%, and make…
U.S. Government Suspends Enrollment in Cigna Medicare Advantage, Drug Plans
(Reuters)—The U.S. government has suspended new enrollment in Cigna Corp’s Medicare Advantage health plans for seniors and standalone Medicare prescription drug plans, citing noncompliance in its appeals and grievances procedures. The government said Cigna had deficiencies in its appeals and grievances processes in both Medicare Advantage and the Medicare prescription drug program, according to a…